WIN KERR, ATP JEREMY K. TORRISI

The copyright holder of this publication assigns unlimited royalty-free

reproduction licensing exclusively to the United States Government and NATO member governments. U.S. Government Printing Offices, specifically Department of Defense installation printing services are authorized to reproduce this publication for use by military personnel.

The copyright holder retains reproduction and royalty licensing for all other individuals or organizations except the U.S. Government. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photography, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

DD1380 TCCC CARD...PAGE 33

TRIAGE & EVACUATION CATEGORIES..PAGE 34

MEDEVAC REQUEST FORMAT....PAGE 35

CASUALTY AAR SUBMISSION.....PAGE 37

COTCCC RECOMMENDED ITEMS..PAGE 40

PLANNING FOR CASUALTY RESPONSE....PAGE 46

KEY REFERENCES & RECOMMENDED READING..PAGE 47

GLOSSARY.....PAGE 51

CONVERSIONS....PAGE 52

DRUG QUICK REFERENCE.....PAGE 53

TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

FORWARD

Tactical Combat Casualty Care (TCCC) has saved hundreds of lives during our nation's conflicts in Iraq andAfghanistan. Nearly 90% of combat fatalities occur before the casualty reaches a Medical treatment facility, itis clear that the prehospital phase of care is the focus of efforts to reduce deaths in combat. Very few militaryphysicians, however, have had training in this area. As a result, at the onset of hostilities, most combatMedics, corpsmen, and para-rescue personnel (PJs) in the US Military were trained to perform battlefieldtrauma care through the use of civilian-based trauma courses that were not designed for the prehospitalcombat environment and did not reflect contemporary knowledge in this area.

This challenge was met by the Committee on TCCC (CoTCCC) voting members and its many liaison membersthat collectively comprise the TCCC Working Group. This remarkably eclectic group includes trauma surgeons,emergency medicine physicians, internists, family medicine physicians, operational physicians and physicianassistants, combat medical educators, trauma researchers, pathologists, combat medical doctrine developers,medical equipment specialists, and combat medics, corpsmen, and PJs. All of the US Armed Services are well-represented in the group's membership and 100% of the CoTCCC voting members have been to war. TheCoTCCC and the TCCC Working Group represents different services, disciplines, and military experiences, allbrought to bear on a single goal - reducing preventable deaths on the battlefield.

No such group existed when the Twin Towers fell. The US Special Operations Command initially funded thegroup as a research effort, then ownership of the group was successively assumed by the Naval OperationalMedicine Institute, the Defense Health Board, and now the Joint Trau-ma System.

This group has taken the TCCC Guidelines as they existed in 2001 and continually updated them throughoutthe 15 years of war, based on input from the Joint Trauma System Performance Improvement traumateleconferences, published case reports and case series from the war zones, breakthroughs in military Medicalresearch, and new publications from the civilian medical literature that bear on combat trauma. It hasprocessed a continual steam of input from the battlefield throughout the war years and ensured thatbattlefield trauma care lessons learned were not just noted, but acted upon.

Through the ongoing volunteer efforts of this dedicated group of individuals - which met quarterly throughoutmost of the war - US Forces have had prehospital trauma care guidelines that were customized for thebattlefield and updated continuously based on real-time evaluation of outcomes from ongoing combatoperations. This is the first time in our nation's history that this has occurred.

The success of TCCC effort had been well documented. It is a great tribute to all of the members of the CoTCCCand the TCCC Working Group, that it has been able to transcend service and Medical specialty differences,process new information expertly, and develop evidence-based, best-practice guidelines that have completelytransformed battlefield trauma care..

It is to the Committee on TCCC and all of our valued colleagues in the TCCC Working Group that this TCCC textis dedicated. Our country and its casualties owe you all a profound measure of thanks.

Massive Hemorrhage Assess for unrecognized hemorrhage and control all life-threatening bleeding.

Use one or more CoTCCC-recommended limb tourniquets if necessary.

Use a CoTCCC approved hemostatic dressing for compressible hemorrhage not amenable to limb tourniquet use.

Immediately apply a CoTCCC-recommended junctional tourniquet if the bleeding site is amenable to use of a junctional tourniquet.Airway Management Unconscious casualty without airway obstruction: -Chin lift or jaw thrust maneuver -Nasopharyngeal airway -Place the casualty in the recovery position Casualty with airway obstruction or impending airway obstruction: -Allow a conscious casualty to assume any position that best protects the airway, to include sitting up -Chin lift or jaw thrust maneuver -Nasopharyngeal airway -Place an unconscious casualty in the recovery position If the previous measures are unsuccessful perform a surgical cricothyroidotomy using one of the following: -CricKey technique -Bougie-aided open surgical technique -Standard open surgical technique *Use lidocaine if the casualty is conscious

4 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

ABBREVIATED TCCC GUIDELINES

31 JAN 2017

Basic Management Plan for Tactical Field Care continued

Respiration/Breathing In a casualty with progressive respiratory distress and known or suspected torso trauma, consider a tension pneumothorax: -Decompress the chest on the side of the injury at the primary or alternate site. All open and/or sucking chest wounds should be treated by: -Applying a vented chest seal (preferred) -Applying a non-vented chest seal -Burp the wound if indicated for breathing difficulty Initiate pulsoximetry monitoring. Monitor for tension pneumothorax. Casualties with moderate/severe TBI should be given supplemental oxygen when available to maintain an oxygen saturation > 90%.Circulation - Bleeding Apply a pelvic binder for suspected pelvic fracture and/or severe blunt force or blast injury. Reassess prior tourniquet application: -Expose the wound and determine if a tourniquet is needed; if bleeding is not controlled then tighten tourniquet if possible. -If the first tourniquet does not control bleeding after tightening, then add a second tourniquet side-by- side with the first. Convert Limb tourniquets and junctional tourniquets if the following three criteria are met: -The casualty is not in shock. -It is possible to monitor the wound closely for bleeding. -The tourniquet is not being used to control bleeding from an amputation. Convert tourniquets in less than 2 hours if bleeding can be controlled with other means. Expose and use an indelible marker to clearly mark all tourniquet sites with the time of tourniquet application, reapplication, conversion, or removal.Circulation - IV/IO Access Start an 18-gauge IV or Saline Lock if indicated. If IV access is not obtainable, use an intraosseous (IO) needle.Circulation - TXA If a casualty is anticipated to need a blood transfusion, then administer 1 gram of tranexamic acid (TXA) in 100ml of NS or LR over 10min ASAP but NOT beyond 3 hours post injury.Circulation - Fluid Resuscitation Assess for hemorrhagic shock: -If not in shock PO fluids are permissible if casualty is conscious and can swallow. -If in shock resuscitate with: Whole blood (preferred) or Plasma, RBCs and platelets (1:1:1) or Plasma and RBCs (1:1) or Plasma or if blood products not available, Hextend or Lactated Ringers or Plasma-Lyte-A Resuscitate with above fluids until a palpable radial pulse, improved mental status or systolic BP of 80-90 mmHg is present. Discontinue fluids when one or more end points are achieved. Reassess casualty frequently to check for recurrence of shock. If shock recurs, verify all hemorrhage is under control and repeat fluid resuscitation as above. 5 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

Analgesia/Pain Management Analgesia on the battlefield should generally be achieved by one of three options: Mild to Moderate Pain and/or Casualty can swallow and is still able to fight: -Administer TCCC Combat Wound Medication Pack (CWMP) Moderate to Severe Pain and casualty IS NOT in Shock -Oral Transmucosal Fentanyl Citrate (OTFC) 800mcg Moderate to Severe Pain and casualty is in hemorrhagic shock or respiratory distress -Administer Ketamine 50mg IM or IN repeating q30min prn OR -Administer Ketamine 20mg Slow IV or IO repeating q20min prn

*Endpoint control of pain or development of nystagmus.

*Consider Ondansetron 4mg ODT/IV/IO/IM q8hours prn for nausea and vomiting.Antibiotics If able to take PO, then administer Moxifloxacin 400mg PO qDaily from CWPP. If unable to take PO, administer Ertapenem 1 gram IV/IM qDaily.Wounds Inspect and dress known wounds. Check for Additional Wounds.Burns Facial burns should be aggressively monitored for airway status and potential inhalation injury. Estimate total body surface area (TBSA) burned to nearest 10%. Cover burned areas with dry, sterile dressings. For burns >20% TBSA, consider placing casualty immediately in HPMK or other hypothermia prevention means. Fluid Resuscitation (USAISR Rule of Ten): -If burns >20% TBSA, initiate IV/IO fluids ASAP with Lactated Ringers, NS, or Hextend. If Hextend, then no more than 1000ml followed by LR or NS as needed. -Initial IV/IO fluid rate = %TBSA X 10ml/per hour for adults 40-80 kg (+100ml/hr for every 10kg above 80kg). -If hemorrhagic shock is present then resuscitate IAW fluid resuscitation in Circulation section. All TCCC interventions may be performed on or through burned skin.

6 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

ABBREVIATED TCCC GUIDELINES

31 JAN 2017

Basic Management Plan for Tactical Field Care continued

Splinting - Splint Fractures and Recheck Pulses.

Communication Communicate with the casualty if possible. Encourage, reassure, and explain care. Communicate with tactical leadership ASAP and throughout treatment. Provide casualty status and evac requirements. Communicate with the evacuation system to arrange TACEVAC. Communicate with medical personnel on evacuation assets and relay mechanism of injury, injuries sustained, signs/symptoms and treatments rendered.DocumentationDocument clinical assessments, treatments rendered, and changes in the casualty's status on a TCCC Casualty Card (DDForm 1380) and forward this information with the casualty to the next level of care.Cardiopulmonary resuscitation (CPR) Battlefield blast or penetrating trauma casualties with no pulse, no ventilations, and no other signs of life should not be resuscitated. Casualties with torso trauma or polytrauma with no pulse or respirations should have bilateral needle decompression performed to confirm/deny tension pneumothorax prior to discontinuing care.

Communication Communicate with the casualty if possible. Encourage, reassure, and explain care Communicate with next level of care and relay mechanism of injury, injuries sustained, signs/symptoms, and treatments rendered.

Casualty moved to cover

LIFE THREATENING BLEEDING:

Use CoTCCC Recommended Limb Limb * Extrication Tourniquet applied YES Tourniquet -Casualties should be extricated from proximal to bleeding Indicated? burning vehicles or buildings and moved site to relative safety. Do what is necessary to stop burning process.

NO Place tourniquets High & Tight if bleeding site is not Continue with Fight / easily identifiable Mission Casualty Movement: - The fastest method is dragging along the long axis of patients body by two rescuers. Airway management is Move casualty to CCP or -Spinal precautions or stabilization should generally best deferred until secure area and initiate only be considered after a casualty is the Tactical Field Care phase Tactical Field Care removed from the enemy threat and indicated by mechanism of injury.

Pelvic Binder Indications- Severe blunt trauma or

blast injury with one or more of the following: YES -Pelvic pain Apply a Pelvic Binder Pelvic Binder indicated? -Any major lower limb amputation/near amputation -Physical exam suggestive of pelvic fracture -Unconsciousness or Shock NO

Each hemostatic works differently. If one

Reassess previously applied tourniquets. fails to control bleeding, it may be removed and a fresh dressing of the same type or a different type applied (Xstat Reassess previously applied hemostatic cannot be removed in the field) dressings/agents

Tourniquet not needed criteria: Loosen tourniquet in <2 hours if

-Minor lacerations w/minimal bleeding can be controlled by Expose wound and NO bleeding other means. Leave tourniquet determine if tourniquet is -Surface Abrasions loosely on limb for rapid needed. -Bleeding controlled by pressure reapplication if needed. Do not dressing remove if TQ in place >6 hours. YES

Leave previous tourniquet in place Note time of tourniquet

release on tourniquet and/or casualty card

Place second tourniquet 2-3 inches

above wound on skin. Control bleeding with hemostatic and/or pressure dressing. Loosen first tourniquet once second tourniquet is effectively placed

Leave tourniquet in place maximum 2 YES

hours of tourniquet time until Bleeding Controlled? reassessment

NO Before 2 hours, reassess: if not in shock, able to monitor the wound closely for bleeding, and no amputation control Move original tourniquet to position next bleeding with hemostatic and/or pressure to second tourniquet directly on skin and dressing. Do not remove if TQ in place tighten both until bleeding stopped and >6 hours. distal pulse not palpated

Initiate 18G IV or Saline Lock

If IV is not obtainable, use IO route

CIRCULATION (TRANEXAMIC ACID)

Administer 1 gm of Tranexamic Acid (TXA) in TXA Criteria:

100 ml of NS or LR IV over 10min YES -Presents with Hemorrhagic Shock TXA Needed? -One or more major amputations Administer as soon as possible after injury Do NOT administer >3hours after injury -Penetrating torso trauma -Evidence of severe bleeding NO

After initial fluid resuscitation, administer

second dose of Tranexamic Acid (TXA) 1 gm in 100 ml of NS or LR IV over 10 min Do NOT administer 3 hours or more after injury

PO fluids permissible if casualty is

YES Blood Products NO

Whole Blood Transfusion Hextend 500 ml bolus Available? OR, if not available OR, if not available Plasma, RBCs, Platelets Lactated Ringers 500 ml 1:1:1 OR Plasma-Lyte A OR, if not available 500 ml bolus Plasma and RBCs 1:1 OR, if not available Plasma (reconstituted, liquid, or thawed) or RBCs Re-assess after each unit or 500 cc bolus administered

Continue fluid resuscitation until:

If altered mental status due to suspected

TBI and has weak/absent radial pulse, then resuscitate to restore normal radial Fluid resuscitation and hypothermia pulse or Systolic BP >90mmHg prevention should be executed simultaneously if possible

After initial fluid resuscitation, administer

second dose of Tranexamic Acid (TXA) 1 gm in 100 ml of NS or LR IV over 10 min Do NOT administer 3 hours or more after injury

Pelvic Binder Indications- Severe blunt trauma or

blast injury with one or more of the following: YES Apply a Pelvic Binder Pelvic Binder indicated? -Pelvic pain -Any major lower limb amputation/near amputation -Physical exam suggestive of pelvic fracture NO -Unconsciousness or Shock

Reassess previously applied tourniquets.

Each hemostatic works differently. If one fails to control bleeding, it may be removed and a fresh dressing of the same Reassess previously applied hemostatic type or a different type applied (Xstat dressings/agents cannot be removed in the field)

Loosen tourniquet in <2 hours if

Tourniquet not needed criteria: bleeding can be controlled by -Minor lacerations w/minimal Expose wound and NO other means. Leave tourniquet bleeding determine if tourniquet is loosely on limb for rapid -Surface Abrasions needed. reapplication if needed. Do not -Bleeding controlled by pressure remove if TQ in place >6 hours. dressing YES

Leave previous tourniquet in place Note time of tourniquet

release on tourniquet and/or casualty card

Place second tourniquet 2-3 inches

above wound on skin. Control bleeding with hemostatic and/or pressure dressing. Loosen first tourniquet once second tourniquet is effectively placed

Leave tourniquet in place maximum 2 YES

hours of tourniquet time until Bleeding Controlled? reassessment

NO Before 2 hours, reassess: if not in shock, able to monitor the wound closely for Move original tourniquet to position next bleeding, and no amputation control to second tourniquet directly on skin and bleeding with hemostatic and/or pressure tighten both until bleeding stopped and dressing. Do not remove if TQ in place distal pulse not palpated >6 hours.

Initiate 18G IV or Saline Lock

If IV is not obtainable, use IO route

CIRCULATION (TRANEXAMIC ACID)

Administer 1 gm of Tranexamic Acid (TXA) in TXA Criteria:

100 ml of NS or LR IV over 10min YES -Presents with Hemorrhagic Shock TXA Needed? -One or more major amputations Administer as soon as possible after injury Do NOT administer >3hours after injury -Penetrating torso trauma -Evidence of severe bleeding NO

After initial fluid resuscitation, administer

second dose of Tranexamic Acid (TXA) 1 gm in 100 ml of NS or LR IV over 10 min Do NOT administer 3 hours or more after injury

Fluid Resuscitation PO fluids permissible if casualty is

(in preferred order/combinations) conscious and can swallow

YES Blood Products NO

Whole Blood Transfusion Hextend 500cc bolus Available? OR, if not available OR, if not available Plasma, RBCs, Platelets 1:1:1 Lactated Ringers 500cc OR Plasma-Lyte A OR, if not available 500cc bolus Plasma and RBCs 1:1

OR, if not available

Plasma (reconstituted, liquid, or thawed) or RBCs Re-assess after each unit or 500 cc bolus administered

Continue fluid resuscitation until:

Palpable radial pulse OR Fluid resuscitation and hypothermia Improved mental status OR prevention should be executed Systolic BP of 80-90 mmHg simultaneously if possible If altered mental status due to suspected TBI and has weak/absent peripheral pulse, then resuscitate to restore normal radial pulse or Systolic BP >90mmHg

After initial fluid resuscitation, administer

second dose of Tranexamic Acid (TXA) 1 gram in 100 cc of NS or LR IV over 10 min Do NOT administer 3 hours or more after injury

Communicate with Communicate with

Encourage, reassure, explain Communicate with medical

care if possible providers on evac asset if possible.

Relay mechanism of injury,

injuries sustained, signs/ symptoms, and treatments rendered.

CPR may be attempted in TACEVAC if

casualty does not have obviously fatal Cardiopulmonary Resuscitation wounds and quickly arriving at a surgical (CPR) capability. CPR should not be attempted Considerations if compromising the mission or denying lifesaving treatment to other casualties.

Casualties with torso or polytrauma with

no pulse or respirations should have bilateral needle decompression performed to confirm/deny tension pneumothorax prior to discontinuing care.

DOCUMENTATION

Document clinical assessments, treatments rendered,

and changes on DD1380 TCCC Card and forward with casualty to next level of care.

Indicates All Combatants

and Combat Lifesaver NEXT LEVEL CARE capability level skill

Indicates Combat Medic

IMMEDIATEThis category includes those casualties who require an immediate LSI and/or surgery. Put simply, if medical attention is not provided they will die.The key to successful triage is to locate these individuals as quickly as possible. Casualties do not remain in this category for an extendedperiod of time. They are either found, triaged and treated, or they die! Hemodynamically unstable casualties with airway obstruction, chest orabdominal injuries, massive external bleeding, or shock deserve this classification.

DELAYEDThis category includes those wounded who are likely to need surgery, but whose general condition permits delay in surgical treatment withoutunduly endangering the life, limb, or eyesight of the casualty. Sustaining treatment will be required (e.g., oral or IV fluids, splinting,administration of antibiotics and pain control), but can possibly wait. Examples of casualties in this category include those with no evidence ofshock who have; large soft tissue wounds, fractures of major bones, intra-abdominal and/or thoracic wounds, and burns to less than 20% of totalbody surface area (TBSA). MINIMALCasualties in this category are often referred as the walking wounded. Although these patients may appear to be in bad shape at first, it is theirphysiologic state that tells the true story. These casualties have minor injuries (e.g., small burns, lacerations, abrasions, or small fractures) thatcan usually be treated with self- or buddy-aid. These casualties should be utilized for mission requirements (e.g., scene security), to help treatand/or transport the more seriously wounded, or put back into the fight.

EXPECTANTCasualties in this category have wounds that are so extensive, that even if they were the sole casualty and had the benefit of optimalmedical resources, their survival would be highly unlikely. Even so, expectant casualties should not be neglected. They should receivecomfort measures and pain medication if possible, and they deserve re-triage as appropriate. Examples of expectant casualties are theunresponsive with injuries such as penetrating head trauma with obvious massive damage to the brain.

EVACUATION PRECEDENCE

URGENT / CATEGORY A PRIORITY / CATEGORY B ROUTINE / CATEGORY C

(WITHIN 2 HOURS) * (WITHIN 4 HOURS) (WITHIN 24 HOURS)

Significant injuries from a dismounted

Isolated, open extremity fracture with IED attack bleeding controlled Concussion (mild traumatic brain injury) Gunshot wound or penetrating shrapnel to Any casualty with a tourniquet in place Gunshot wound to extremity - bleeding chest, abdomen, or pelvis Penetrating or other serious eye injury controlled without tourniquet Any casualty with ongoing airway Significant soft-tissue injury without Minor soft-tissue shrapnel injury difficulty major bleeding Closed fracture with intact distal pulses Any casualty with ongoing respiratory Extremity injury with absent distal pulses Burns over < 10% Total Body Surface difficulty Burns over 10-20% of Total Body Surface Area Unconscious casualty Area Casualty with known or suspected spinal injury Casualty in shock Casualty with bleeding that is difficult to control Moderate/Severe TBI * Note that by Secretary of Defense directive, all casualties categorized as CAT A in the Burns greater than 20% Total Body Afghanistan theater of operations should be able to be evacuated to an MTF with a surgical Surface Area capability within 60 minutes from the time that the evacuation mission is approved.

34 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

MEDEVAC REQUEST

MEDEVAC REQUEST 9-LINE

LINE 1: LOCATION OF UNIT HLZ GRID (MGRS):

LINE 2: CALLSIGN AND CALLSIGN:

FREQUENCY AT THE PZ FREQUENCY:

LINE 3: NUMBER AND A: Number of Urgent Casualties

PRECEDENCE OF CASUALTIES B: Number of Priority Casualties C: Number of Routine Casualties

LINE 4: SPECIAL EQUIPMENT A: None

REQUIRED B: Hoist C: Extraction D: Ventilator E: Other (specify)LINE 5: NUMBER OF L: Number of Litter CasualtiesCASUALTIES BY TYPE A: Number of Ambulatory Casualties E: Number of Escorts

(CBRN CONTAMINATION IF APPLICABLE) departure headings and type of predominant terrain for the HLZ

In accordance with and excerpted from

Army Training Publication (ATP) 4-02.2 (Medical Evacuation)

35 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

MIST REPORT FORMAT

MIST REPORT

M MECHANISM OF INJURY AND TIME OF INJURY (IF Mechanism of Injury and time of injury (if known)KNOWN)

I INJURY OR ILLNESS Injury or Illness

S SYMPTOMS AND VITAL SIGNS A Airway status

B Breathing rate C Pulse rate D Conscious/Unconscious E Other signs

T TREATMENT GIVEN Such as Tourniquet/Time Applied

Drugs administered

36 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

POINT-OF-INJURY / TCCC AFTER ACTION REPORT

The POI/TCCC AAR can be found electronically at:

www.cotccc.com or www.usaisr.amedd.army.mil/pdfs/POI_TCCC_AAR_26Apr2013.pdf or atn.army.mil.

The TCCC AAR is to be completed within 72 hours of the injury

occurring, by the POI Medical team or Role I, and sent to the DoD Trauma Registry (DoDTR).

E-mail To: usarmy.jbsa.medcom-aisr.list.jts-trauma-registry@mail.mil.

The DoDTR is the data repository for DoD trauma-related injuries. The goal of this registry is to document, inelectronic format, information about the demographics, injury-producing incident, diagnosis and treatment, andoutcome of injuries sustained by US/Non-US military and US/ Non-US civilian personnel in wartime and peacetimefrom the point of wounding to final disposition. The JTS collects data from TCCC cards (DD Form 1380, TCCC AARsand from the Armed Forces Medical Examiner Services (AFMES). Documentation is vital to accumulate data in theDoD Trauma registry, formerly the Joint Theater Trauma Registry (JTTR). The JTS functions as:

2. Trauma Care Delivery maintains a database of operational and physiologic parameters related todelivery of en route care and has evaluated the validity of the "Golden Hour" standard for movement of casualtiesfrom point of injury to the first surgical capability. The addition of a military en route care registry (MERCuRY) willcapture all ground, air and ship transport care.

AIRWAY MANAGEMENT DEVICES & ADJUNCTS

Common Name / Brand Name DLA Nomenclature NSN Control Cric / CricKey Cricothyrotomy System 6515-01-640-6701

DLA Defense Logistics Agency

DLA Nomenclature is the naming convention terminology used in DoD supply systems and often differ from common, brand, or product names.

NSN National Stock Number. A NSN is 13-digit code identifying all standardized material supply items recognized by NATO countries and the DoD.

40 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

TCCC PHARMACOLOGY REFERENCE

The TCCC pharmacology reference provides drug information as based on administration

based solely on the TCCC Guidelines. These references should not be used for the administration of these medications for any environment outside of tactical combat casualty care on the battlefield or in the combat/tactical setting.

TRANEXEMIC ACID (TXA, CYKLOKAPRON)

Class: Antifibrinolytic agentTCCC Indications: For patients anticipated to need significant blood transfusion; hemorrhagic shock, one or more majoramputations, penetrating torso trauma, or evidence of severe bleeding.DOSE: 1 gram in separate 100cc of NS or LR slow IV push over 10 min. Do not administer in same bag as blood products orHextend. Administer a second infusion of 1 gram after 500cc fluid challenge.Administration Instructions: Administer as soon as possible but not later than 3 hours after injury. Ensure documentation oncasualty card and/or attach/write on patients chest wall.Contraindications: subarachnoid hemorrhage, active intravascular clotting, Pregnancy Category B.Adverse/Side Effects: Blurred vision or impaired color vision. Gastrointestinal disturbances (nausea, vomiting, diarrhea) mayoccur but disappear when the dosage is reduced. Hypotension has been observed when intravenous injection is too rapid. Toavoid this response, the solution should not be injected more rapidly than 100mg per minute.Interactions: should not be administered concomitantly with Factor IX Complex concentrates or Anti-inhibitor Coagulantconcentrates, as the risk of thrombosis may be increased.

45 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

EXAMPLE TACTICAL MEDICAL CONOP

46 TACTICAL COMBAT CASUALTY CARE (TCCC / TC3)

ABOUT THE COMMITTEE ON TACTICAL COMBAT CASUALTY CARE AND THE JOINT TRAUMA SYSTEM

CoTCCC MISSION: To develop on an ongoing basis the best possible set of trauma care guidelines customized for the tactical environment and to facilitate the transition of these recommendations into battlefield trauma care practice.

The Committee on Tactical Combat Casualty Care (CoTCCC) is the Prehospital arm of the Joint Trauma System for the Department of Defense.

The CoTCCC is composed of 42 voting members specially selected as subject-matter experts in trauma, battlefield medicine, tactical medicine, prehospital medicine and their experience in the deployed combat environment.

The TCCC Working Group is composed of the CoTCCC and hundreds of subject-matter experts across many domains and liaisons from DoD, Government and Partner nation organizations.

The CoTCCC and the TCCC Working Group focus all of their efforts on providing the best recommendations for training andequipment for our individual service members, combat medics, corpsman, pararescue, and med techs going into harm's way around the world.

JTS MISSION: The mission of the Joint Trauma System (JTS) is to provide evidence- based process improvement of trauma and combat casualty care, to drive morbidity and mortality to the lowest possible levels, and to provide evidence-based recommendations on trauma care and trauma systems across the Department of Defense (DoD).

The DoD CENTER OF EXCELLENCE FOR TRAUMA

DATA ACQUISITION: Mines the medical records to abstract, code, and enters critical trauma data into the DoDTR database for use in support of the JTS mission.

DATA ANALYSIS: Develops queries and provides data from the DoDTR in response to requests for information. Conducts classified and non-classified data analysis.

DATA AUTOMATION: Supports the information technology for the DoDTR and data-related special projects. Designs and implementsspecial-project database applications, related architecture, and documentation. Handles documentation needs for JTS to maintain Program compliance with the Defense Health Agency.